OMS complications

[Smilemaker100]

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Hello there, fellow dentists and dentists 2 B!

I was wondering about how many people out there (dental students/dentists), forget about their patients once they return home...Someone once told me that when they finish their day at work, they leave their work related issues for the next day...I can't seem to let go 😀 . I have a tendency to "bring" my work with me...reflect over cases and think about what should have been done, can or cannot be done.

There is this case in particular which I wanted to get feedback on. 😕 A patient of mine had an appointment with me a few days ago to get some extractions (isolated # 2, isolated # 15 and # 16 with a small space in between #15 and #16). There was generalized horizontal bone loss (about 50%) The roots of these teeth were above average long. #2 was extracted without any complications, however, when I extracted # 15 and #16, buccal bone came out with both of them. Antibiotics and painkillers were prescribed. There wasn't much bone before extraction so you can imagine the post-exo situation. 😱 Basically just tissue flapping around. I felt like I was really no better than some butcher like the barber surgeons were a few hundred years ago 🙁 Someone told me that the only other way I could have avoided this situation was to divide the teeth into three pieces (each root) and remove each part individually.

How can I deal with this ? She still has a few upper anterior teeth left that have to be extracted. Someone suggested that I extract the posteriors, wait for the posterior areas to heal and then take a dual impression before removing the remaining anteriors. When should I have the patient come in to get the final impression ? I've never faced a case like this. What would you tell this patient in regards to the future treatment if this were your patient?

Any useful advice would be appreciated. 👍 Thanks!

Smilemaker100

 

[toofache32]

Antibiotics and painkillers were prescribed.

Why antibiotics?

 

[DDSSlave]

I assume this is one of your first few extractions? Bottom line is you'll get better. As for this particular patient, in your consent you mentioned there may be a loss of bone or damage to surrounding tissues, something like that? I'd tell them their extractions were successfully completed, but there was some loss of bone on one side. You're just going to have to wait to let it heal before you can accurately tell how it will affect the final denture. Without a radiograph, it would be impossible to say whether you needed to split the tooth. If that was the case the OS or dentists covering you should have thrown out that possibility before surgery. One suggestion may be to have a little more patience when luxating and don't be so aggressive. Remember how thin that cortical plate is. As far as timing that depends on what you are making for her - an immediate or traditional complete denture? Sounds like an immediate. Also, why antibiotics?

 

[UBTom]

I remember when I was a senior in dental school, I'd watch a few third-years on oral surgery rotation with me, and now and then they will do one of those posterior max extractions where they'd accidentally tear out a big chunk of the tuberosity. 😱

Since then I've gone to great lengths to make sure I'd detach the PDL on the max 3rd molars down to the alveolar margin before trying to elevate and luxate!

I'd say max 3rds are my favorite teeth to extract... Once the PDL is properly detached, it's a breeze to lever it distally with an elevator against the alveolus mesial to the tooth and it pops out so easily. 😎

 

[Smilemaker100]

I assume this is one of your first few extractions? Bottom line is you'll get better. As for this particular patient, in your consent you mentioned there may be a loss of bone or damage to surrounding tissues, something like that? I'd tell them their extractions were successfully completed, but there was some loss of bone on one side. You're just going to have to wait to let it heal before you can accurately tell how it will affect the final denture. Without a radiograph, it would be impossible to say whether you needed to split the tooth. If that was the case the OS or dentists covering you should have thrown out that possibility before surgery. One suggestion may be to have a little more patience when luxating and don't be so aggressive. Remember how thin that cortical plate is. As far as timing that depends on what you are making for her - an immediate or traditional complete denture? Sounds like an immediate. Also, why antibiotics?

Dear DDSSlave,

Antibiotics were prescribed because of the more traumatic nature of the surgery (such as impacted wisdom teeth in which you had to do a flap and osteotomy, like my case- more trauma-bone loss, and sometimes risk of having an oroantral exposure) in which there is higher risk of infection.

Actually, it wasn't one of my first extractions. Anyone who has ever extracted ISOLATED maxillary molars, knows that there is a risk of fracture of the tuberosity or bone. You mentioned that I should have been less aggressive...actually, I was taking my time and going really slowly- it wasn't the reason why is happened. I am actually in a GPR program right now and I asked the advice of an attending who has a lot of experience in surgery. He said the situation was not really avoidable. When I asked him how it could have been avoided, he said if I had sectioned the teeth in 3 and removed each part individually, it would have lessened the chances. Even experienced dentists can come across a situation like this and I have even heard of similar cases from dentists.

 

[DrJeff]

As the saying goes, stuff happens. Don't feel bad about it, because with isolated max posteriors, like you correctly stated, the bone just "grabs" on and hold like a bear from time to time. The flip side, if you sectioned them, you'd lay a big flap (as you know anytime you lay a flap you'll get some bone resorption) and then in sectioning out the teeth and subsequent alveolplasty to deal with the socket anatomy, you'd likely end up with a fairly similar final bony anatomy 😀

In a situation where you do break off a decent chunk of bone, after taking a deep breath and restarting your heart 😀 , often what you need to do is first reapproximate the tissue, and then feel for any sharp bony contours that need to be taken care of with either a rongeur or a bone file. After that's done and you've irrigated the heck out of the site, look at how the tissue comes together, and if you need to excise any tissue to achieve a good primary closure.

Now for restorative purposes, I'll routinely see the patient in about 4 weeks to evaluate tissue healing and bony remodeling. In most patients I'll then take the dual impression for immediate dentures about 6 weeks after posterior removal.

Lastly, if the informed consent forms at your GPR haven't changed any since I was there, I know that one of the things thats mentioned on the consent form is breakage of bone, so you've presumably mentioned this to the patient. If you continue to take out alot of teeth during your career, I'll guarentee you that this won't be the only time you take a big chunk of alveolus out with a tooth 😱 😀

P.S. given the home care habits of many of the patients at your GPR, I gave alot of ABX post surgery where I was loking at a big flap/large areas of bone exposure 😉 Since many of them you could actually see walking out og the hospital, taking out there guaze pressure packs and lighting up a smoke 😕 😡 🙄

 

[DDSSlave]

Dear DDSSlave,

Antibiotics were prescribed because of the more traumatic nature of the surgery (such as impacted wisdom teeth in which you had to do a flap and osteotomy, like my case- more trauma-bone loss, and sometimes risk of having an oroantral exposure) in which there is higher risk of infection.

Actually, it wasn't one of my first extractions. Anyone who has ever extracted ISOLATED maxillary molars, knows that there is a risk of fracture of the tuberosity or bone. You mentioned that I should have been less aggressive...actually, I was taking my time and going really slowly- it wasn't the reason why is happened. I am actually in a GPR program right now and I asked the advice of an attending who has a lot of experience in surgery. He said the situation was not really avoidable. When I asked him how it could have been avoided, he said if I had sectioned the teeth in 3 and removed each part individually, it would have lessened the chances. Even experienced dentists can come across a situation like this and I have even heard of similar cases from dentists.

Fair enough. You sound somewhat irritated with my response. If it came across in anyway condescending I certainly didn't intend that. Just giving the best advice I know with what was presented. My question regarding whether this was one of your first extractions was not base on your surgery, but on your questions about when to take impressions etc. My mistake.

Also, I did read "isolated" correctly the first time and do have experience with such teeth. I have broken the buccal plate on a similar tooth myself and was equally frustrated. Certainly this is a common frustration in dental school and even in private practice.

Did you have an oroantral exposure? For the majority of extractions involving flaps, bone loss, and/or max posteriors I have not prescribed antibiotics. Is that wrong?

 

[toofache32]

The antibiotic aspect to this post interests me the most. Our OMS clinic in my residency sees between 80-100 patients for extractions per day. This is a county hospital where "toothbrush allergies" are the rule. I bet less than 10 patients each day are given antibiotics...only in cases of frank pus or severely debilitated health. Some of the guys don't even give antibiotics for pus, as long as the source of the infection (the tooth) is removed and drainage is established. We don't give antibiotics for wisdom teeth unless there is a clear reason either. I have rarely seen anyone come back for reasons of continued infection.

I think many dentists give out antibiotics for unfounded reasons, and the public has come to expect them for any extraction (in my humble experience). I'm still not clear on why antibiotics were given due to the "more traumatic nature of the surgery." We routinely lay larger flaps to chop off tori and don't give antibiotics, and I have never seen a problem.

 

[DrJeff]

Sometimes you've gotta just go on gut instinct. And I'm sure that you've seen enough now to know when that "questionable" case will arise when all indicators suggest that antibiotics aren't needed, but you'll give them on that isolated instance.

BTW, I like that "toothbrush allergy" line. I'll have to start incorporating that into some of my patient speeches! 😀

 

[toothcaries]

my very first extraction was also an isolated posterior tooth...
...and i also delivered some buccal bone with the tooth.
i remember feeling like i was the biggest hack in the world at that time...

...

does anyone use a "pott's instrument" of max 3rd molars? (i think that's the name-an elevator with a curved rounded face)
..it's makes luxating toward the distal very efficient.

Hello there, fellow dentists and dentists 2 B!

I was wondering about how many people out there (dental students/dentists), forget about their patients once they return home...Someone once told me that when they finish their day at work, they leave their work related issues for the next day...I can't seem to let go 😀 . I have a tendency to "bring" my work with me...reflect over cases and think about what should have been done, can or cannot be done.

There is this case in particular which I wanted to get feedback on. 😕 A patient of mine had an appointment with me a few days ago to get some extractions (isolated # 2, isolated # 15 and # 16 with a small space in between #15 and #16). There was generalized horizontal bone loss (about 50%) The roots of these teeth were above average long. #2 was extracted without any complications, however, when I extracted # 15 and #16, buccal bone came out with both of them. Antibiotics and painkillers were prescribed. There wasn't much bone before extraction so you can imagine the post-exo situation. 😱 Basically just tissue flapping around. I felt like I was really no better than some butcher like the barber surgeons were a few hundred years ago 🙁 Someone told me that the only other way I could have avoided this situation was to divide the teeth into three pieces (each root) and remove each part individually.

How can I deal with this ? She still has a few upper anterior teeth left that have to be extracted. Someone suggested that I extract the posteriors, wait for the posterior areas to heal and then take a dual impression before removing the remaining anteriors. When should I have the patient come in to get the final impression ? I've never faced a case like this. What would you tell this patient in regards to the future treatment if this were your patient?

Any useful advice would be appreciated. 👍 Thanks!

Smilemaker100

 

[toofache32]

Sometimes you've gotta just go on gut instinct. And I'm sure that you've seen enough now to know when that "questionable" case will arise when all indicators suggest that antibiotics aren't needed, but you'll give them on that isolated instance.

BTW, I like that "toothbrush allergy" line. I'll have to start incorporating that into some of my patient speeches! 😀

I definately agree with the gut instinct, I know exactly what you're talking about.

I used the "toothbrush allergy" line once while on internal medicine in med school, and they loved it. They also got a kick out of me describing a guy with only 2 maxillary teeth remaining (one on each side) as a "seven-ten split." I guess you have to go bowling to understand it.

 

[Smilemaker100]

As the saying goes, stuff happens. Don't feel bad about it, because with isolated max posteriors, like you correctly stated, the bone just "grabs" on and hold like a bear from time to time. The flip side, if you sectioned them, you'd lay a big flap (as you know anytime you lay a flap you'll get some bone resorption) and then in sectioning out the teeth and subsequent alveolplasty to deal with the socket anatomy, you'd likely end up with a fairly similar final bony anatomy 😀

In a situation where you do break off a decent chunk of bone, after taking a deep breath and restarting your heart 😀 , often what you need to do is first reapproximate the tissue, and then feel for any sharp bony contours that need to be taken care of with either a rongeur or a bone file. After that's done and you've irrigated the heck out of the site, look at how the tissue comes together, and if you need to excise any tissue to achieve a good primary closure.

Now for restorative purposes, I'll routinely see the patient in about 4 weeks to evaluate tissue healing and bony remodeling. In most patients I'll then take the dual impression for immediate dentures about 6 weeks after posterior removal.

Lastly, if the informed consent forms at your GPR haven't changed any since I was there, I know that one of the things thats mentioned on the consent form is breakage of bone, so you've presumably mentioned this to the patient. If you continue to take out alot of teeth during your career, I'll guarentee you that this won't be the only time you take a big chunk of alveolus out with a tooth 😱 😀

P.S. given the home care habits of many of the patients at your GPR, I gave alot of ABX post surgery where I was loking at a big flap/large areas of bone exposure 😉 Since many of them you could actually see walking out og the hospital, taking out there guaze pressure packs and lighting up a smoke 😕 😡 🙄

Thanks, Dr Jeff! 👍

I never did a dual impression while I was a dental student. According to what I understand, I use the same materials one uses for final impressions for the posterior region and I take an alginate impression for the anterior region. Am I missing anything? It really isn't clear to me. How do you do your dual impressions?

Thanks again.
Smilemaker100

 

[Smilemaker100]

The antibiotic aspect to this post interests me the most. Our OMS clinic in my residency sees between 80-100 patients for extractions per day. This is a county hospital where "toothbrush allergies" are the rule. I bet less than 10 patients each day are given antibiotics...only in cases of frank pus or severely debilitated health. Some of the guys don't even give antibiotics for pus, as long as the source of the infection (the tooth) is removed and drainage is established. We don't give antibiotics for wisdom teeth unless there is a clear reason either. I have rarely seen anyone come back for reasons of continued infection.

I think many dentists give out antibiotics for unfounded reasons, and the public has come to expect them for any extraction (in my humble experience). I'm still not clear on why antibiotics were given due to the "more traumatic nature of the surgery." We routinely lay larger flaps to chop off tori and don't give antibiotics, and I have never seen a problem.

I have a microbiology & immunology background and am well aware of the molecular aspects of antibiotic resistance. For most simple extractions I don't prescribe antibiotics. I don't routinely give antibiotics in OMS cases except for the following:

1) pericoronitis

2) traumatic surgeries in which there is bone exposure such as the removal of impacted lower wisdom teeth

3) immunocompromised patients

 

[Doggie]

I have a microbiology & immunology background and am well aware of the molecular aspects of antibiotic resistance. For most simple extractions I don't prescribe antibiotics. I don't routinely give antibiotics in OMS cases except for the following:

1) pericoronitis

2) traumatic surgeries in which there is bone exposure such as the removal of impacted lower wisdom teeth

3) immunocompromised patients

In all the examples that you have given, except #3, would prescribing Peridex have sufficed?

 

[Smilemaker100]

In all the examples that you have given, except #3, would prescribing Peridex have sufficed?

I usually suggest Peridex as an ajunct for certain cases of adult periodontitis (as a periodontal chip or rinse). Other uses of Peridex...before implants are placed, the surgeon will usually suggest that the patient rinse their mouth with the solution. When I rinse a dry socket region, I will use Peridex and give the patient a syringue which they can use at home to irrigate with Peridex. Long term use of peridex/chlorexidine gluconate , as most of you know , is not recommended because of staining (which is not so good for anterior restorations- difficult to remove) ,increase of tartar deposits, changes of taste, some patients demonstrate hypersensitivity.

 

[Smilemaker100]

In all the examples that you have given, except #3, would prescribing Peridex have sufficed?

I usually suggest Peridex as an ajunct for certain cases of adult periodontitis (as a periodontal chip or rinse). I don't usually suggest Peridex for extraction cases. Rinsing with salted water after the first day actually has some antibacterial effects. Other uses of Peridex...before implants are placed, the surgeon will usually suggest that the patient rinse their mouth with the solution. When I rinse a dry socket region, I will use Peridex and give the patient a syringue which they can use at home to irrigate with Peridex. Long term use of peridex/chlorexidine gluconate , as most of you know , is not recommended because of staining (which is not so good for anterior restorations- difficult to remove) ,increase of tartar deposits, changes of taste, and some patients demonstrate hypersensitivity.

 

[TuffyDMD]

Hi everyone, this is my first post but I think I can offer some advice. During my shadowing experience I noticed that my dentist would give vankomiacin? IV prior to every procedure. He said that this would reduce the amount of bacteria deposited into the blood stream with minor soft tissue trauma. I don't see why you wouldn't give them for all patients since the amount of bacteremia caused by the events you named above is the same for toothbrushing and flossing.

 

[DrJeff]

Thanks, Dr Jeff! 👍

I never did a dual impression while I was a dental student. According to what I understand, I use the same materials one uses for final impressions for the posterior region and I take an alginate impression for the anterior region. Am I missing anything? It really isn't clear to me. How do you do your dual impressions?

Thanks again.
Smilemaker100

For my duals, I'll mainly just use a polyether (Impregum) in a custom tray nowadays and wash the remaining teeth with some polyvinyl(or often just the polyether alone), but I did one with alginate/rubber base at SF and Romeo was a big help with advising me on it. (He seemed to like the dual technique as a lab tech alot more than me as the clinician)

It's really quite easy, the most difficult part though is getting the patient prepped ahead of time for what to expect when the immediate goes in with respect to eating ability and stability of the denture. That's where you want them thinking that the final result will be an annoying, loose piece of plastic. This way when it fits pretty well and they can eat 90% of their original diet without problems you look like the greatest dentist ever!

 

[DrJeff]

Hi everyone, this is my first post but I think I can offer some advice. During my shadowing experience I noticed that my dentist would give vankomiacin? IV prior to every procedure. He said that this would reduce the amount of bacteria deposited into the blood stream with minor soft tissue trauma. I don't see why you wouldn't give them for all patients since the amount of bacteremia caused by the events you named above is the same for toothbrushing and flossing.

Basically its a cost benefit situation, IV Vancomycin is expensive, and the actual incidence of post extraction infection is very, very low. So do you want to hit the patient with an extra bill of likely $100 or more (Vancomycin, IV tube, Syringe, site prep material, etc) for a result that would very likely be the same without the antibiotic??? Plus, if you wanted to get similar IV coverage, there are much more cost effective drugs that would get bacterial coverage (I.E. Penicillin G, ampicillin, or even Clindamycin).

 

[Smilemaker100]

For my duals, I'll mainly just use a polyether (Impregum) in a custom tray nowadays and wash the remaining teeth with some polyvinyl(or often just the polyether alone), but I did one with alginate/rubber base at SF and Romeo was a big help with advising me on it. (He seemed to like the dual technique as a lab tech alot more than me as the clinician)

It's really quite easy, the most difficult part though is getting the patient prepped ahead of time for what to expect when the immediate goes in with respect to eating ability and stability of the denture. That's where you want them thinking that the final result will be an annoying, loose piece of plastic. This way when it fits pretty well and they can eat 90% of their original diet without problems you look like the greatest dentist ever!

Dr Jeff,

Poor Romeo...O Romeo, Romeo! Wherefore art thou Romeo! 😛 (sorry I can't help it! 😀 The only Romeo I ever heard of before was in that Shakespearean play...I am a big Shakespeare fan!). Romeo has been away for a while because of an injury to his arm 🙁 which I think happened when he went on some fishing expedition. I think he'll be coming back in about another 2 weeks.

Speaking of my coming across some of your "experiments" 😛 during your residency...I was taking a look at some of my OR cases for next week and saw your name and Dr D's as the operators in 1999...first time I saw your name in a file.

Thanks for your advice!

Smilemaker100

 

[Bitters]

Any dentist giving IV vancomycin for routine extractions on healthy patients is guilty of malpractice. There is no indication for it whatsoever.

 

[aphistis]

Any dentist giving IV vancomycin for routine extractions on healthy patients is guilty of malpractice. There is no indication for it whatsoever.

This is kinda what I was thinking, but didn't think I could adequately justify.

 

[DrJeff]

Speaking of my coming across some of your "experiments" 😛 during your residency...I was taking a look at some of my OR cases for next week and saw your name and Dr D's as the operators in 1999...first time I saw your name in a file.


Smilemaker100

You mean Dr D and I actually left some teeth in a patients mouth 😉 😀 If it was in the Spring/Summer of '99 there was a good chance then that it was a nice warm day and we were in a hurry to go waterskiing 😱 😉 😀

 

[Smilemaker100]

You mean Dr D and I actually left some teeth in a patients mouth 😉 😀 If it was in the Spring/Summer of '99 there was a good chance then that it was a nice warm day and we were in a hurry to go waterskiing 😱 😉 😀

So it appears ...but this patient will be seen by Dr M not Dr D next week. Is there anything wrong with having pity on the patient and leaving him with at least SOME teeth ?! I don't think Dr D does this waterskiing business anymore because he goes straight to the clinic afterward. I think his kids are probably enough of a work out for him given their ages!

Who drove the boat? Who waterskiied? I am a pretty good swimmer
( completed all my Red Cross levels(Canada) and lifesaving but not lifeguarding) but I would be scared S**TLESS (I think my heart would just leap out of my chest!) at the thought of waterskiing (especially if someone was driving the boat quickly) or other risky behavior such as bungee jumping and certain roller coasters . 😱 I can't believe you actually did that

 

[TuffyDMD]

Any dentist giving IV vancomycin for routine extractions on healthy patients is guilty of malpractice. There is no indication for it whatsoever.

Bitters, maybe you should graduate your program before you go and critisize a liscenced dentist. My dad who is a pharmacist told me that dentists don't learn how to practice real dentistry until they graduate.

Even though I have 2 months of dental school under my belt, I know enough about dentistry to know what is appropriate and what is overkill. By the way, I am an occupational therapist so I probably have a greater medical background than the average D4.

 

[DrJeff]

Who drove the boat? Who waterskiied? I am a pretty good swimmer
( completed all my Red Cross levels(Canada) and lifesaving but not lifeguarding) but I would be scared S**TLESS (I think my heart would just leap out of my chest!) at the thought of waterskiing (especially if someone was driving the boat quickly) or other risky behavior such as bungee jumping and certain roller coasters . 😱 I can't believe you actually did that

Many times, I'd be driving as he'd be barefoot waterskiing hanging onto a bar sticking off the side of the boat at about 38mph 😱 Fortunately the way his boat is set up, you could get away without a spotter (as long as the marine patrol wasn't around 😉 )

 

[Smilemaker100]

Many times, I'd be driving as he'd be barefoot waterskiing hanging onto a bar sticking off the side of the boat at about 38mph 😱 Fortunately the way his boat is set up, you could get away without a spotter (as long as the marine patrol wasn't around 😉 )

Life on the edge! That must really get the adrenaline up! He's great to work with.

 

[toofache32]

Bitters, maybe you should graduate your program before you go and critisize a liscenced dentist. My dad who is a pharmacist told me that dentists don't learn how to practice real dentistry until they graduate.

Even though I have 2 months of dental school under my belt, I know enough about dentistry to know what is appropriate and what is overkill. By the way, I am an occupational therapist so I probably have a greater medical background than the average D4.

I usually don't respond this way to posts, but every sentence here is just too unbelievable.

First of all, Bitters is absolutely correct. Vancomycin is one of our last big guns against resistant bacteria, and anyone (DDS or MD) using it for normal oral flora is nothing short of an idiot. The unanswered question here is, "What are the antibiotics protecting?" The indications are well-studied and very specific (certain murmers, shunts, prostheses) Arguments might be made for TREATMENT of a dental infection with Vanc, but PROPHYLAXIS is ridiculous and not defensible. Failure to respond to traditional antibiotics (Pen, Clinda) may be an indication to try Vanc.

Second, the fact that someone is "criticizing a licensed dentist" is irrelevant. Not to mention the fact that Bitters is also a licensed dentist currently in an OMS program (correct me if I'm wrong). A license is given only for passing the minimal requirements and does not protect you from the legal consequences of malpractice, whether its DDS, MD or OT. Ask any attorney.

As for the comment from your dad the pharmacist (which I actually agree with...partly), I'm not clear on how being a pharmacist makes an opinion valid on another profession. I don't feel qualified to comment on when a pharmacist "learns to practice real pharmacy."

Even though I have 2 months of dental school under my belt, I know enough about dentistry to know what is appropriate and what is overkill. By the way, I am an occupational therapist so I probably have a greater medical background than the average D4.

You can't be serious. You already know enough about dentistry...after 2 months? Unbelievable. I'm not even gonna approach the comment about an OT's medical background compared to a dentist's...especially in regards to the mechanisms of antibiotic coverage and resistance.

Hi everyone, this is my first post but I think I can offer some advice. During my shadowing experience I noticed that my dentist would give vankomiacin? IV prior to every procedure. He said that this would reduce the amount of bacteria deposited into the blood stream with minor soft tissue trauma.

Nothing can change the amount of bacteria deposited in the bloodstream from manipulating the oral tissues. Antibiotics only render the bloodstream sterile by eliminating the bacteria that do get into the blood. Don't worry, I didn't have that topic in my first 2 months of dental school either.

I don't see why you wouldn't give them for all patients since the amount of bacteremia caused by the events you named above is the same for toothbrushing and flossing...

...and for sneezing and defecating. You get a bacteremia during all of these events, but people don't become septic every time they pinch a loaf. Or maybe I should take some IV Vanc next time I'm on my way to sit on the porcelain. Antibiotic prophylaxis is ONLY given for recognized indications as published by the ADA/AHA. Refer again to my previous comment about having only 2 months of dental school under your belt.

 

[Doggie]

You get a bacteremia during all of these events, but people don't become septic every time they pinch a loaf. Or maybe I should take some IV Vanc next time I'm on my way to sit on the porcelain.

HAHAHAHA.....you are just too funny.

Here's a side question.....under the guidelines for premedication of dental procedures, why is it that for an MI, premedication should be given only if the last MI was within 6 months? Is it cuz of the necrotic tissue in the heart chamber that could possibly cause bacterial vegetations?

 

[toofache32]

HAHAHAHA.....you are just too funny.

Here's a side question.....under the guidelines for premedication of dental procedures, why is it that for an MI, premedication should be given only if the last MI was within 6 months? Is it cuz of the necrotic tissue in the heart chamber that could possibly cause bacterial vegetations?

You may be thinking about "no elective dental procedures" within 6 months of an MI, not antibiotic prophylaxis. I don't remember recent MI being on the list for antibiotic prophylaxis, but somebody correct me if I am wrong. However, complications from an MI (murmer, surgical valve replacement, etc.) can require prophylaxis. Elective dental procedures should be avoided in the first 6 months because this is the most likely time for a repeat MI.

The ADA and AHA get together every few years to update their recommendations. I found a couple of links from the AHA website:

http://www.americanheart.org/presenter.jhtml?identifier=1729

http://www.americanheart.org/presenter.jhtml?identifier=4548

 

[aphistis]

You may be thinking about "no elective dental procedures" within 6 months of an MI, not antibiotic prophylaxis. I don't remember recent MI being on the list for antibiotic prophylaxis, but somebody correct me if I am wrong. However, complications from an MI (murmer, surgical valve replacement, etc.) can require prophylaxis. Elective dental procedures should be avoided in the first 6 months because this is the most likely time for a repeat MI.

The ADA and AHA get together every few years to update their recommendations. I found a couple of links from the AHA website:

http://www.americanheart.org/presenter.jhtml?identifier=1729

http://www.americanheart.org/presenter.jhtml?identifier=4548

Sorry, toofache, but judging by what Gavin posted in another thread, you just fell for bait from one of your distinguished OMS colleagues trolling as TuffyDMD. Ain't fratricide a bummer?

 

[Bitters]

Troll, thats why no response. Good reply. agree with you

 

[north2southOMFS]

I don't know, I think that their may be some merit to what Tuffy has to say. Maybe Tuffy is smarter than all of you. I hear occupational therapy is a very difficult and challenging degree to get. After all his uncle is a denturist. By the way, what does fratricide mean....help me out, i'm only a dentist.

 

[toofache32]

Sorry, toofache, but judging by what Gavin posted in another thread, you just fell for bait from one of your distinguished OMS colleagues trolling as TuffyDMD. Ain't fratricide a bummer?

...hook, line, and sinker 😡

If its who I think it is...is this the thanks I get for letting him sleep in my house and drink all my beer for a month?

 

[ItsGavinC]

Just a reminder to NOT feed the trolls.

If a post is too dumb to believe, that's because it was written by a troll, or by an OMS resident at LSUMC (must be a slow program if it's residents find ample time to troll an internet forum).

 

[doctorsquared]

Smilemaker, I think you worry too much. Sometimes buccal bone comes out with the teeth. If you don't have a hole to the sinus then don't worry. You'll manage to make a denture. Remember you are not responsible for a patient's decision not to brush and floss. There are potential risks and complications to any oral surgery procedure. You are sweating the small stuff. If the patient really cared they would not have 50% bone loss.

It's okay to worry about your patients when it's irreversible and causes a change in life pleasure. Keep your worrying to the major stuff like nerve damage, heart attacks in your chair, breaking bones.

 

[Smilemaker100]

Smilemaker, I think you worry too much. Sometimes buccal bone comes out with the teeth. If you don't have a hole to the sinus then don't worry. You'll manage to make a denture. Remember you are not responsible for a patient's decision not to brush and floss. There are potential risks and complications to any oral surgery procedure. You are sweating the small stuff. If the patient really cared they would not have 50% bone loss.

It's okay to worry about your patients when it's irreversible and causes a change in life pleasure. Keep your worrying to the major stuff like nerve damage, heart attacks in your chair, breaking bones.

Thanks...yes, I know , I shouldn't sweat the "small stuff". I suppose I was worried because I am a "embryonic dentist"...I still don't have enough experience so whenever I come across something new, it is natural for me to get a little worried. Next time this happens, my heart won't skip a beat 😛